Oral contraceptive and drugs interactions

Hi Doc,

My girlfriend has been in a panic lately about her contraceptive pill (mercilon). Previously she has always had a bar in her arm but switched 2 months ago to the pill. Do any of the following affect how well the pill works: Mephedrone, methylone, cocaine, mdma, alcohol or in any combination of the above?

Originally posted in SR 2.0 7/4/14 . Reviewed 8/2/23

There are no  significant pharmacological interactions between common  drugs and birth control pills. The use of substances you mention does not alter efficacy of birth control pills. Neither any other hormone-based method: patches, transdermal implants, vaginal rings …

Equally important, contraceptive efficacy of the «morning-after pill» is also not affected

There are some studies that suggest  pharmacological interactions between cannabinoids and some contraceptives . But these are experiments «in vitro» and do not seem to have any practical relevance in humans.

And the same goes for combinations. We will consider «combination» the use of moderate doses and reasonable frequencies of a few substances. «Drug salads» ( taking whatever anyone offers to you without  criteria) often have unpredictable effects, regardless of the use of contraceptives or any other medication.

In relation to drugs and hormonal contraceptives, one important exception is tobacco. Women who smoke tobacco are at increased risk of certain adverse effects.  Smoking increases hormone levels in the blood, which can lead to an increased risk of blood clots, myocardial infarction and stroke.

In addition, smoking is associated with a decrease in good (HDL) cholesterol levels and an increase in bad (LDL) cholesterol levels. This contributes also to cardiovascular problems.

It is therefore recommended that women using oral contraceptives do not smoke (especially women over 35 years of age). If a woman is unwilling or unable to quit smoking, it is reasonable to consider another method of contraception.

Like many other drugs, oral contraceptives are used on a daily basis.So, it is important not to forget doses in order to maintain their effectiveness. This can be significant in the context of a rave or party lasting several days. In any case, weekly or monthly contraceptives are available for people who have a tendency to forget to take a drug every day.

High dosage MDMA risks

Doctor, very important question:

I am concerned risks about high dosage MDMA. I took MDMA with a friend, for each was the first time. I guess i may think that i have a strange natural tolerance to any drugs, since I’ve tried speed, coke, also DOM, and less more than nothing came. And so i decided to use a quite large amount of the substance, it would has been 0,5 for me 0,4 for him.

The fact is before we was pretty drunk too, and after 10 minutes I drank it in a glass of water I was beginning to fell the effects, some time after I WAS NO LONGER MYSELF. I’ve never felt, like i said, something that before. my friend was having a great time too. We hugged, danced, even while there were moments in which I struggled my friend was ever felt good.
the day after him was acting in a strange way, kinder than usual, talkative with people who didn’t know, and what fears me, a bit stupid, asking stupid question… and this not only the day after, but the second and the following

this is the fourth day, we have returned from holiday and I won’t longer see him very often… ah, I am 80 kg and him… mmh he’s tall 2 metres so will be 90 kg or so.

my question is: I’m have to be afraid? or him are experiencing only longer side effect? i’m really worried…

I can definitely say that it was my first experience whit a drug, weed isn’t ever comparable with this, that sensation to be out of mind… but what’s the reason? why only md has affected me? it can be the setting of the moment, while I was in good mood by alchool?
I didn’t expect to fell sensations this great, I am a little afraid now although i don’t fell particularly strange, only tired for lack of sleep, so I hope nothing happened at least to me

really thank you doctor

Originally posted in SR 2.0 3/8/14 . Reviewed 10/02/23

Common recreational dosage of MDMA are is 1.5- 2 mg/kg, or 100-150 mg for someone of average weight. These are the same dosages used in clinical trials. For beginners, a somewhat lower dose of 70-100 mg is recommended.Women need slightly lower doses to achieve same effects than men.

Taking a high dosage of 400 or 500 mg can be dangerous and result in adverse or toxic effects. Additionally, mixing with large amounts of alcohol can worsen the situation.

It’s important to remember that just because you may have tried other drugs in the past or require a high dosage to feel the effects, this does not mean that the same is true for MDMA.

In most cases, high doses of MDMA are not typically associated with long-term toxic effects.Usually, symptoms diminish with time and dissapear in a few days. Good quality sleep helps.

In reality, high doses of MDMA are not typically associated with long-term toxic effects. Symptoms may diminish and eventually disappear in the days following use. However, if they persist for more than 7-10 days, it’s advisable to seek medical advice. This is, however, a rare occurrence. Most people recover after a few days of rest and good quality sleep.

High dosages increase risk of appearance and severity of MDMA adverse effects

MDMA, SSRI antidepressants and serotonin syndrome risk

Does combining MDMA with an SSRI lead to an increased risk of serotonin syndrome?

Originally posted in SR forum 6/7/13 . Reviewed 9/2/23

There have been many clinical trials in humans co-administrating different SSRIs (paroxetine, citalopram, sertraline…) to study pharmacological properties.




There is a theoretical risk but it is probably overestimated. According to a recent systematic review (one of the highest quality methods of scientific research)  this situation is exceptional.


Anyway, combination of MDMA and SSRI is not recommended.

First because, in general, it lowers MDMA effects.

Second because people under SSRI treatment usually suffer problems as depression or anxiety disorders and, MDMA is not recommended because of these problems.

In animal models combination of MDMA and some SSRI showed lower neurotoxicity.But doses and patterns of administration make that these results can´t be extrapolated to humans. It is not likely that SSRIs have a neuroprotective effect in humans at doses available.

In my opinion risk of neurotoxicity associated to MDMA is sometimes exagerated. There is no evidence that occasional moderate doses (lower than 120-150 mg) have any neurotoxic effects. In fact at least four investigation teams have been administrating MDMA to healthy human volunteers in clinical trials with the approval of sanitary authorities and ethical comitees of clinical trials. In this case neuroprotective drugs are unnecessary. People who take large doses during long time are probably more exposed to this risks, and in this case there are no neuroprotective measures that have shown efficacy.

Substances that inhibit monoamine oxidase (MAOI: phenelzine, moclobemide) are most likely to lead to serious increases in serotonin when used with ecstasy, and develop a serotonin syndrome. In people who use these drugs MDMA is absolutely not recommended.

MDMA / LSD and sildenafil combination

Is it safe having sildenafil with lsd or mdma in combination?

Originally posted in SR 2.0 16/4/14. Reviewed 9/2/23

There are no reported cases of severe toxicity mixing MDMA or LSD and sildelnafil. The combination is probably safe from a pharmacological point of view.

The risk of problems or adverse effects depends on dosage, timing, previous experience with both substances and personal characteristics. Some common effects of sildenafil (headache, nasal congestion) could be enhanced by psychedelic effects.

Let’s just say that when it comes to exploring the depths of sexuality and substances , it’s all about finding the right dose. 

The psychedelic effects of low to moderate doses of LSD can offer a unique perspective on sex that some people may find interesting. Too much LSD and you’ll be absorbed by a fractal  kaleidoscope of colors, completely forgetting about any naughty intention.

Something similar (though less intense) happens with MDMA. Low to medium doses can intensify and modify the qualities of sex, and a moderate dose of sildenafil can help a man maintain an erection (if that is what is intended). Increasing the dose is more likely to result in deep conversation, cuddling and cuddling (which isn’t bad either). In the latter case, sildenafil is likely to be ineffective and have mostly adverse effects.

In any case, the most dangerous combination is between PDE-5 inhibitors (Viagra, Cialis, Levitra…) and poppers. Both substances causes rapid blood flow and risks of  low blood pressure and fainting are common. In rare cases or persons with previous cardiological diseases it is possible to suffer more severe problems (heart attack, arrythmias…)

MDMA adverse effects

MDMA adverse effects

I’m still relatively new to MDMA.. well, I shouldn’t say MDMA – I should say Party Pills as I guess I really don’t know what I’m taking (I’m buying a test kit soon).I love taking party pills because it’s much better to spend $50 – $75 (on pills) on a night out rather than $200 – $300 (on alcohol). But, my only worry is health risks. The only health risks I know about are, anxiety/paranoia from taking too much (only happened once to me), and over heating – which I avoid by drinking water every 1-2 hours. Is there any other health risks that I should be worried about?  I guess you could say memory loss, but I have much more memory loss when drinking alcohol.

Originally posted in SR2.0 Forum 3/2/14 Updated 2/2/23

Common side effects of MDMA include loss of appetite, visual distortions, nystagmus (involuntary eye movement), increased heart rate and blood pressure, edginess, body temperature changes, vomiting, anxiety, perspiration, motion sickness, confusion, dry mouth, jaw tension, and difficulty concentrating. However, not all of these effects occur in everyone, and the dose and frequency are determining factors. Some individuals may be more prone to these negative effects than others.

Hyperthermia is a severe but rare side effect that is more likely to occur in crowded spaces, during intense physical activity such as dancing, and when proper hydration is not maintained. To prevent this, it’s recommended to take breaks from dancing, replenish fluids (with water, juice, or isotonic beverages, in moderation, about half a liter per hour for intense physical activity and less for rest), and avoid or limit alcohol, as it increases dehydration and body heat. Moderation and common sense should guide fluid intake, rather than counting exact amounts.

MDMA increases heart rate and blood pressure, so those with heart conditions or hypertension should exercise caution when using it. High and continuous doses of MDMA in frequent users can lead to memory loss and mood alterations in the future. The rule of thumb for MDMA use is «Less is more.» Bad side effects and long-term consequences decrease, and the experience becomes more enjoyable, if there is more time between doses. It is estimated that using MDMA more than once a month can be excessive. Moderating its use is the key to fully experiencing its effects and preventing long-term consequences.

It’s impossible to know a pill’s concentration of MDMA without laboratory analysis. Reagent kits are available to detect the most common adulterant